Diagnostic and pathophysiological aspects of psychogenic tremors
Diagnostic and pathophysiological aspects of psychogenic tremors
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DOI：
10.1002/mds.870130216
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发表时间：
1998-03-01
影响因子：
8.6
通讯作者：
Scheidt, C
中科院分区：
文献类型：
--
作者：
Deuschl, G;Köster, B;Scheidt, C
心因性震颤已成为一种罕见的运动障碍。25例运动障碍患者在站立时表现出明显的非器质性身体抖动或四肢震颤。突然发作和一个可变的，但很少缓解过程的条件是常见的。“心因性震颤的共同激活征象”和无指震颤是区分器质性震颤的最一致的标准。对震颤的定量分析表明，当肢体负荷额外的负荷时，大多数器质性震颤的幅度减小。相反，我们发现大多数心因性震颤的病例震颤幅度增加。这可能是由于增加共激活以维持振荡。这些临床和电生理特征提示，协同激活诱发的颤振机制是心因性肢体震颤的病理生理基础。精神病学评估并未显示大多数患者有明显的歇斯底里症状。然而，我们发现抑郁症和功能性躯体或心身疾病在患者中很常见。应对压力的能力下降可能是一个重要的原因。这种疾病的临床过程通常远非良性。我们的结论是，心因性震颤在大多数患者中可以通过神经学体征来确诊，而不仅仅是一种排除性诊断。不良的结果使得早期和认真的神经精神治疗尝试是必要的。
Psychogenic tremor has become a rare movement disorder. Twenty-five patients from our movement disorder unit presented either with obviously nonorganic body shaking during stance or with extremity tremors. A sudden onset and a variable but rarely remitting course of the condition was common. The "coactivation sign of psychogenic tremor" and absent finger tremor were the most consistent criteria to separate them from organic tremors. Quantitative analysis of tremor shows decreasing amplitudes in most organic tremors when the extremity is loaded with additional wrights. In contrast, we found an increase of tremor amplitude for most of the cases with psychogenic tremor. This might be caused by increased coactivation to maintain the oscillation. These clinical and electrophysiological features suggest a clonus mechanism induced by coactivation as the pathophysiological basis of psychogenic extremity tremor. Psychiatric evaluation did not show overt signs of hysteria for the majority of the patients. However, we found depression and functional somatic or psychosomatic conditions to be frequent among the patients. A reduced ability to cope with stressful situations may play a significant rule. The clinical course of the condition is usually far from benign. We conclude that psychogenic tremor can be positively diagnosed by means of neurologic signs in the majority of patients and is not only a diagnosis of exclusion. The poor outcome makes early and serious neuropsychiatric attempts at therapy necessary.